Glycemic Control and Type 2 Diabetes Mellitus: The Optimal Hemoglobin A1c Targets. A Guidance Statement from the American College of Physicians

Glycemic Control and Type 2 Diabetes Mellitus: The Optimal Hemoglobin A_1c Targets. A Guidance Statement from the American College of Physicians

Amir Qaseem, MD, PhD, MHA;
Sandeep Vijan, MD, MS;
Vincenza Snow, MD;
J. Thomas Cross, MD, MPH;
Kevin B. Weiss, MD, MPH;
Douglas K. Owens, MD, MS; and
for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians*

From the American College of Physicians, Philadelphia, Pennsylvania; Veterans Affairs Health Services Research and the University of Michigan, Ann Arbor, Michigan; Medstudy, Colorado Springs, Colorado; Hines Veterans Affairs Hospital, Hines, Illinois; Northwestern University, Chicago, Illinois; Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and Stanford University, Stanford, California

Abstract

This guidance statement is derived from other organizations' guidelines and is based on an evaluation of the strengths and weaknesses of the available guidelines. We used the Appraisal of Guidelines, Research and Evaluation in Europe (AGREE) appraisal instrument to evaluate the guidelines from various organizations. On the basis of the review of the available guidelines, we recommend:

Statement 1: To prevent microvascular complications of diabetes, the goal for glycemic control should be as low as is feasible without undue risk for adverse events or an unacceptable burden on patients. Treatment goals should be based on a discussion of the benefits and harms of specific levels of glycemic control with the patient. A hemoglobin A_1c level less than 7% based on individualized assessment is a reasonable goal for many but not all patients.

Statement 2: The goal for hemoglobin A_1c level should be based on individualized assessment of risk for complications from diabetes, comorbidity, life expectancy, and patient preferences.

Statement 3: We recommend further research to assess the optimal level of glycemic control, particularly in the presence of comorbid conditions.

*This paper, written by Amir Qaseem, MD, PhD, MHA; Sandeep Vijan, MD, MS; Vincenza Snow, MD; J. Thomas Cross, MD, MPH; Kevin B. Weiss, MD, MPH; and Douglas K. Owens, MD, MS, was developed for the American College of Physicians' Clinical Efficacy Assessment Subcommittee: Douglas K. Owens, MD, MS (Chair); Donald E. Casey Jr., MD, MPH, MBA; J. Thomas Cross Jr., MD, MPH; Paul Dallas, MD; Nancy C. Dolan, MD; Mary Ann Forciea, MD; Lakshmi Halasyamani, MD; Robert H. Hopkins Jr., MD; and Paul Shekelle, MD, PhD. Approved by the ACP Board of Regents on 28 October 2006.

Article and Author Information

Note: Guidance statements are guides only and may not apply to all patients and all clinical situations. Thus, they are not intended to override clinicians' judgment. All ACP guidance statements are considered automatically withdrawn or invalid 5 years after publication or once an update has been issued.
Grant Support: Financial support for the development of this guideline comes exclusively from the ACP operating budget.
Potential Financial Conflicts of Interest: Grants received: V. Snow (Agency for Healthcare Research and Quality, Centers for Disease Control and Prevention, Novo Nordisk, Bristol-Myers Squibb, Pfizer Inc., Merck Pharmaceuticals). Receipt of payment for manuscript preparation: S. Vijan (American College of Physicians).
Requests for Single Reprints: Amir Qaseem, MD, PhD, MHA, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, aqaseem{at}acponline.org.
Current Author Addresses: Drs. Qaseem and Snow: American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.
Dr. Vijan: Veterans Affairs Health Services Research, 2215 Fuller Road, Mailstop 11H, Ann Arbor, MI 48105.
Dr. Cross: Medstudy, 1761 South 8th Street, Suite H, Colorado Springs, CO 80906.
Dr. Weiss: Hines Veterans Affairs Hospital, PO Box 5000, Hines, IL 60141.
Dr. Owens: Veterans Affairs Palo Alto Health Care System, 117 Encina Commons, Stanford, CA 94305.

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